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General NPI Number Information
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NPI Number | 1326223041
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Entity Type | Organization
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Legal Business Name | HM CENTRAL LAB, LLC
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Dates
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Enumeration Date | 12/31/2007
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Last Update Date | 01/25/2019
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Provider Practice Location Address
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Address Line | 2944 MOTLEY DR SUITE 105
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City | MESQUITE
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State | TX
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Zip | 75150-3460
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Country | US
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Telephone | 972-613-5793
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Fax | 972-613-7236
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Provider Business Mailing Address
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Address Line | 2944 MOTLEY DR STE 100
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City | MESQUITE
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State | TX
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Zip | 75150-3405
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Country | US
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Telephone | 972-613-5793
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Fax | 972-613-7236
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Authorized Official
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Title or Position | C.E.O.
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Name | ROBERTO ENRIQUEZ
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Credential | M.T.
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Telephone | 214-274-3478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 45D1014980
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License Number State | TX
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